Application of motor learning principles to complex surgical tasks: searching for the optimal practice schedule.

Practice of complex tasks can be scheduled in several ways: as whole-task practice or as practice of the individual skills composing the task in either a blocked or a random order. The authors used those 3 schedules to study 18 participants' learning of an orthopedic surgical task. They assessed learning by obtaining expert evaluation of performance and objective kinematic measures before, immediately after, and 1 week after practice (transfer test). During acquisition, the blocked group showed superior performance for simple skills but not for more complex skills. For the expert-based measures of performance, all groups improved from pretest to posttest and remained constant from posttest to transfer. Measures of the final product showed that the whole-practice group's outcomes were significantly better than those of the random group on transfer. All groups showed better efficiency of motions in the posttest than in the pretest. Those measures were also poorer on the transfer test than on the posttest. The present evidence does not support the contextual interference effect--hypothetically, because of the inherent cognitive effort effect associated with some of the component skills. The authors recommend that surgical tasks composed of several discrete skills be practiced as a whole. The results of this study demonstrate the importance of critically appraising basic theories in applied environments.